Enhanced education on vaccines can reduce the
AUTHOR:
Chenjerayi Kashangura1
AFFILIATION:
1
Biological Sciences Department,
University of Zimbabwe, Harare,
Zimbabwe
CORRESPONDENCE TO:
Chenjerayi Kashangura
EMAIL:
ckashangura@kutsaga.co.zw
HOW TO CITE:
Kashangura C. Enhanced education
on vaccines can reduce the scourge
of vaccine rejection and hesitation.
S Afr J Sci. 2020;116(9/10),
Art. #8143, 2 pages. https://doi.
org/10.17159/sajs.2020/8143
ARTICLE INCLUDES:
☐ Peer review
☐ Supplementary material
KEYWORDS:
artificial intelligence, bioengineering,
deep learning, virus, virtual reality,
gaming
PUBLISHED:
29 September 2020
© 2020. The Author(s). Published
under a Creative Commons
Attribution Licence.
Scientific Correspondence
https://doi.org/10.17159/sajs.2020/8143
scourge of vaccine rejection and hesitation
Development and improvement of vaccines are benefitting from advances in life sciences fields such as synthetic
biology. However, amidst this technological revolution, the field of vaccinology faces challenges in keeping up with
evolving viral pathogens and adverse vaccine response outcomes due to human genetic diversity. Moreover, anti-
vaccination attitudes create a higher incidence of vaccine hesitation and rejection.
Global health is facing challenges from evolving existing pathogens that are becoming multidrug resistant and thus
reducing the available therapeutic interventions that can be employed. Moreover, novel pathogens are emerging,
such as the current pandemic of SARS-Coronavirus 2 (SARS–Cov-2). Some of the hot topics in vaccination –
namely efficacy, impact and attitudes – were highlighted in an Elsevier Vaccine Special Article Collection1 that
also identified some of the challenges in vaccinology. These challenges include anti-vaccine thinking that leads to
increased levels of vaccine rejection and the need to work fast to produce a vaccine such as the annual flu vaccine
which must match new strains.1 Developing vaccines is usually a race against time as the viral particles mutate and
recombine and thus require annual development ab initio. Successful vaccinology depends partly on the vaccines
interacting with the immune system and producing an immune response similar to that produced by the natural
infection, but usually not creating clinical disease symptoms and potential complications.2 Vaccines can be in the
form of live attenuated pathogen, virus-like particles, killed sub-unit, killed virus and viral components such as
polysaccharide and protein3 that result in long-term protection that requires the persistence of vaccine antibodies
and/or the generation of immune memory cells that are capable of rapid and effective reactivation upon subsequent
exposure to the pathogen.3
Genetic diversity in populations is essential as high levels of diversity usually correspond to fitness or adaptability
to environments. Thus, any change in the environment will most likely have a corresponding adaptive genome
already present in the population. A population that is highly genetically uniform would need mutations to occur to
adapt to a new environment and, in the absence of mutations, fitness is lowered, and the population tends towards
extinction. However, for vaccinology, high genetic diversity is not ideal as the interaction of genetic factors, such as
polymorphisms in genes encoding immune response proteins – HLA molecules, cytokines and cytokine receptors
– and environmental factors such as the dose, route of administration and quality of antigen can result in non-
uniform or unexpected outcomes.4,5 These may include adverse side effects or complications after the vaccine is
administered. This genetic variation in both humans and the pathogen causes antigenic variation in the infectious
agent and a high inter-individual variability in the human response to the vaccine6 which prevents the attainment of
a universally effective vaccine. On the other hand, a genetically uniform population would potentially have uniform
outcomes after administering a vaccine. Africa has rich human genetic diversity7 which needs to be taken into
account in developing and evaluating vaccines.
Enhanced vaccine development in the form of multidisciplinary synergistic approaches may enable novel ways
to develop vaccines that utilise the rapidly growing field of artificial intelligence (AI) in silico deep learning, deep
reasoning, reading and vision capabilities. Novel algorithms can reduce genetic diversity to uniform demes, predict8,
model and select the strain to use. In addition, the algorithms can be developed to: consider human genetic variants
that determine disease susceptibility9, identify potential vaccine-adverse outcomes, genetic signatures, suggest
improvements to a candidate therapeutic agent and take into consideration the existing genetic diversity of the
human species races, local demes and that within the pathogen. This would assist in producing a situation of high
human genetic diversity within the population separated in silico into genetically uniform demes and the prediction
of potential vaccine-adverse outcomes signatures. Vaccines for genetically uniform populations would be likely to
reduce adverse side effects. Building on the experience and outcomes of the first phase of algorithm development
and testing, AI algorithms that predict the ability of potential vaccine candidates to ‘inhibit pathogen multiplication’
or ‘cell receptor binding’ might be developed. Testing algorithms using available molecular databases of protein
and nucleic acid sequences of components of pathogen particles, pathogen therapeutic agents, and available
literature may enable rapid discovery or suggest the form of a candidate therapeutic agent. Employing AI in vaccine
development has potential in determining in silico whether one or several different vaccines are required against
a pathogen. The efficacy of the candidate therapeutic agent can then be improved through bioengineering, for
example, synthetically derived nucleic acid or protein domains that are tailor-made for the identified different genetic
groups that elicit an immune response in a safe way that does not produce clinical symptoms.
However, the fast production of an effective vaccine does not ensure vaccine success, as anti-vaccine beliefs are
becoming widespread.1 Thus, educating the public about vaccines, both novel and in use, needs to move from
disseminating vaccine facts to ‘enhanced vaccine education’.
Social media is one route through which polarised attitudes towards vaccination are popularised.10 Enhanced
vaccine education may take a multidisciplinary approach that includes traditionally non-allied activities such as
virtual reality games, smartphone apps and cartoons, to conceptualise vaccinology processes and their attendant
challenges. Teams can develop games and apps that present vaccine development, evaluation and vaccine facts in
‘fun’ ways to the public; these can be made available on online app stores, on social media platforms, in children’s
gaming arcades and even as part of the school curriculum. The educational media can cater for different age
groups. This approach can potentially counter the ‘infodemic’ on vaccine science and reduce incidences of vaccine
hesitation and rejection.
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September/October 2020

Vaccine development and education can also benefit from a further
paradigm shift towards development specific to localised genetic
diversity and other ways to develop antivirals and thus partly address
the current challenges that lead to vaccine hesitation and rejection.
References
1. Elsevier Vaccine Special Article Collection. Hot topics in vaccination: Efficacy,
impact and attitudes. Vaccine. 2018;36 [cited 2020 Mar 18]. Available from:
https://www.elsevier.com/life-sciences/journals/hot-topics-in-vaccination
2. US Centers for Disease Control and Prevention (CDC). Principles of vaccination.
In: Epidemiology and prevention of vaccine-preventable diseases. 13th ed.
Washington DC: Public Health Foundation, CDC; 2015. p. 1–8. Available from:
https://www.cdc.gov/vaccines/pubs/pinkbook/prinvac.html
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Elsevier Saunders; 2013. p. 14–32. https://doi.org/10.1016/B978-1-4557-
0090-5.00004-5
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Scientific Correspondence
https://doi.org/10.17159/sajs.2020/8143
Enhanced vaccine education to reduce rejection/hesitation
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5. O’Connor D, Png E, Khor CC, Snape MD, Hill AVS, Van der Klis M, et al.
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10. Gesualdo F, Zamperini N, Tozzi AE. To talk better about vaccines, we should
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